A Case of Percutaneous Thrombectomy for Internal Carotid Artery Occlusion due to In-Stent Thrombosis Following Stent-Assisted Intra-Aneurysmal Embolization
Objective: In-stent thrombosis (IST) is a known complication after stent-assisted coil (SAC) embolization. We report a case of mechanical thrombectomy using a stent retriever (SR) for IST and share our experience with this treatment to prevent a poor outcome in future cases. Case Presentation: The p...
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| Format: | Article |
| Language: | English |
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The Japanese Society for Neuroendovascular Therapy
2021-01-01
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| Series: | JNET |
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| Online Access: | https://www.jstage.jst.go.jp/article/jnet/15/9/15_cr.2020-0084/_pdf/-char/en |
| _version_ | 1819012065255227392 |
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| author | Yuya Furukawa Tsuyoshi Ichikawa Yuki Harigane Haruhiko Kikuta Kenichiro Nagai Kyouichi Suzuki Yoichi Watanabe |
| author_facet | Yuya Furukawa Tsuyoshi Ichikawa Yuki Harigane Haruhiko Kikuta Kenichiro Nagai Kyouichi Suzuki Yoichi Watanabe |
| author_sort | Yuya Furukawa |
| collection | DOAJ |
| description | Objective: In-stent thrombosis (IST) is a known complication after stent-assisted coil (SAC) embolization. We report a case of mechanical thrombectomy using a stent retriever (SR) for IST and share our experience with this treatment to prevent a poor outcome in future cases. Case Presentation: The patient was a 62-year-old man. SAC embolization for an unruptured left internal carotid artery (ICA) aneurysm was performed. Three weeks after discharge, right hemiparesis and aphasia developed. Magnetic resonance imaging (MRI) demonstrated cerebral infarction in the left middle cerebral artery (MCA) territory and the left ICA was occluded. His relatives told us that the patient discontinued taking antiplatelet drugs. IST was diagnosed and emergency thrombectomy was performed. First, we tried to introduce an aspiration catheter or balloon catheter into the occluded lesion, but they were unable to be sufficiently inserted to the distal site. Therefore, we used a SR even though it carried a risk of friction on the deployed stent. The occluded artery was finally recanalized using the SR, but the stent became shortened. For the treatment strategy, sufficient medication (antithrombogenic agents and edaravone) should be administered first, followed by mechanical treatment. In mechanical treatment, thrombus fragmentation with a guidewire or balloon and aspiration should be attempted first. New aspiration catheters to carry the devices to the far distal site easily are now available. Conclusion: SRs cannot be utilized for thrombectomy with a stent. In emergency situations, careful consideration during troubleshooting rather than using a SR is needed. |
| first_indexed | 2024-12-21T01:38:07Z |
| format | Article |
| id | doaj.art-15935103e2dd4c7ea1e097a8255da1c9 |
| institution | Directory Open Access Journal |
| issn | 1882-4072 2186-2494 |
| language | English |
| last_indexed | 2024-12-21T01:38:07Z |
| publishDate | 2021-01-01 |
| publisher | The Japanese Society for Neuroendovascular Therapy |
| record_format | Article |
| series | JNET |
| spelling | doaj.art-15935103e2dd4c7ea1e097a8255da1c92022-12-21T19:20:13ZengThe Japanese Society for Neuroendovascular TherapyJNET1882-40722186-24942021-01-0115959560110.5797/jnet.cr.2020-0084jnetA Case of Percutaneous Thrombectomy for Internal Carotid Artery Occlusion due to In-Stent Thrombosis Following Stent-Assisted Intra-Aneurysmal EmbolizationYuya Furukawa0Tsuyoshi Ichikawa1Yuki Harigane2Haruhiko Kikuta3Kenichiro Nagai4Kyouichi Suzuki5Yoichi Watanabe6Department of Neurosurgery, Japanese Red Cross Fukushima Hospital, Fukushima, Fukushima, JapanDepartment of Neurosurgery, Japanese Red Cross Fukushima Hospital, Fukushima, Fukushima, JapanDepartment of Neurosurgery, Japanese Red Cross Fukushima Hospital, Fukushima, Fukushima, JapanDepartment of Neurosurgery, Japanese Red Cross Fukushima Hospital, Fukushima, Fukushima, JapanDepartment of Neurosurgery, Japanese Red Cross Fukushima Hospital, Fukushima, Fukushima, JapanDepartment of Neurosurgery, Japanese Red Cross Fukushima Hospital, Fukushima, Fukushima, JapanDepartment of Neurosurgery, Japanese Red Cross Fukushima Hospital, Fukushima, Fukushima, JapanObjective: In-stent thrombosis (IST) is a known complication after stent-assisted coil (SAC) embolization. We report a case of mechanical thrombectomy using a stent retriever (SR) for IST and share our experience with this treatment to prevent a poor outcome in future cases. Case Presentation: The patient was a 62-year-old man. SAC embolization for an unruptured left internal carotid artery (ICA) aneurysm was performed. Three weeks after discharge, right hemiparesis and aphasia developed. Magnetic resonance imaging (MRI) demonstrated cerebral infarction in the left middle cerebral artery (MCA) territory and the left ICA was occluded. His relatives told us that the patient discontinued taking antiplatelet drugs. IST was diagnosed and emergency thrombectomy was performed. First, we tried to introduce an aspiration catheter or balloon catheter into the occluded lesion, but they were unable to be sufficiently inserted to the distal site. Therefore, we used a SR even though it carried a risk of friction on the deployed stent. The occluded artery was finally recanalized using the SR, but the stent became shortened. For the treatment strategy, sufficient medication (antithrombogenic agents and edaravone) should be administered first, followed by mechanical treatment. In mechanical treatment, thrombus fragmentation with a guidewire or balloon and aspiration should be attempted first. New aspiration catheters to carry the devices to the far distal site easily are now available. Conclusion: SRs cannot be utilized for thrombectomy with a stent. In emergency situations, careful consideration during troubleshooting rather than using a SR is needed.https://www.jstage.jst.go.jp/article/jnet/15/9/15_cr.2020-0084/_pdf/-char/enin-stent thrombosisstent-assisted coil embolizationthrombectomyantiplateletsmedication adherence |
| spellingShingle | Yuya Furukawa Tsuyoshi Ichikawa Yuki Harigane Haruhiko Kikuta Kenichiro Nagai Kyouichi Suzuki Yoichi Watanabe A Case of Percutaneous Thrombectomy for Internal Carotid Artery Occlusion due to In-Stent Thrombosis Following Stent-Assisted Intra-Aneurysmal Embolization JNET in-stent thrombosis stent-assisted coil embolization thrombectomy antiplatelets medication adherence |
| title | A Case of Percutaneous Thrombectomy for Internal Carotid Artery Occlusion due to In-Stent Thrombosis Following Stent-Assisted Intra-Aneurysmal Embolization |
| title_full | A Case of Percutaneous Thrombectomy for Internal Carotid Artery Occlusion due to In-Stent Thrombosis Following Stent-Assisted Intra-Aneurysmal Embolization |
| title_fullStr | A Case of Percutaneous Thrombectomy for Internal Carotid Artery Occlusion due to In-Stent Thrombosis Following Stent-Assisted Intra-Aneurysmal Embolization |
| title_full_unstemmed | A Case of Percutaneous Thrombectomy for Internal Carotid Artery Occlusion due to In-Stent Thrombosis Following Stent-Assisted Intra-Aneurysmal Embolization |
| title_short | A Case of Percutaneous Thrombectomy for Internal Carotid Artery Occlusion due to In-Stent Thrombosis Following Stent-Assisted Intra-Aneurysmal Embolization |
| title_sort | case of percutaneous thrombectomy for internal carotid artery occlusion due to in stent thrombosis following stent assisted intra aneurysmal embolization |
| topic | in-stent thrombosis stent-assisted coil embolization thrombectomy antiplatelets medication adherence |
| url | https://www.jstage.jst.go.jp/article/jnet/15/9/15_cr.2020-0084/_pdf/-char/en |
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